Provider Demographics
NPI:1962762724
Name:STUART ORTHOTICS LLC
Entity type:Organization
Organization Name:STUART ORTHOTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT/CERTIFIED ORTHOTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:STUART
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:360-577-3505
Mailing Address - Street 1:1555 3RD AVE STE B
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-3268
Mailing Address - Country:US
Mailing Address - Phone:360-577-3505
Mailing Address - Fax:360-577-3509
Practice Address - Street 1:1555 3RD AVE
Practice Address - Street 2:SUITE B
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-3266
Practice Address - Country:US
Practice Address - Phone:360-577-3505
Practice Address - Fax:360-577-3509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-25
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies